纤维十二指肠镜逆行胆胰管造影放置胆道内塑料支架姑息治疗晚期恶性胆道梗阻临床研究及护理体会
时间：2018-02-17
目的：探讨总结纤维十二指肠镜逆行胆胰管造影放置胆道内塑料支架姑息治疗晚期恶性胆道梗阻的临床研究及护理体会。方法：选取58例2014年1月至10月到我院就医的确诊患者，进行ERCP放置胆道内塑料支架姑息治疗。研究ERCP放置胆道内支架姑息治疗前后总胆红素、直接胆红素、碱性磷酸酶、天冬氨酸转移酶、丙氨酸氨基转移酶变化情况。随访患者生存时间，观察术后患者并发症发生率以及术前护理和术后并发症护理。结果：恶性胆道梗阻患者经ERCP放置胆道内塑料支架姑息治疗成功率高达93.1%，术后胆道引流有效率为20.7%；术后患者总胆红素、直接胆红素、碱性磷酸酶、天冬氨酸转移酶、丙氨酸氨基转移酶等指标均显著下降（P<0.05）。随访45例，平均生存时间（28.0±1.5）个月（4-38个月），1年生存率为55.6%（25/45），2年生存率为26.7%（12/45），术后并发症发生率为8.6%，并发症经术后积极护理均得到缓解或消除。结论：通过纤维十二指肠镜逆行胆胰管造影放置胆道内塑料支架姑息治疗晚期恶性胆道梗阻是可行的，并发症较低，经有效护理治疗均可使并发症得到缓解或消失。
[Abstract] Objective To expore and summarize the cinica study and nursing experience of paiative treatment of advanced maignant biiary obstruction with pastic stent paced in the bie duct under fibrotic duodenoscopy retrograde choangiopancreatography. Methods 58 patients diagnosed with maignant biiary obstruction admitted in our hospita from January to October 2014 were seected and underwent paiative treatment of bie duct with pastic stent paced in the bie duct in ERCP. The success rate and the biiary resuscitation rate of pastic stent paced in the bie duct under ERCP for the paiative treatment were studied. The changes of tota biirubin， direct biirubin， akaine phosphatase， aspartate transferase and aanine aminotransferase in patients were detected. The surviva time of patients was foowed up. The incidence of postoperative compications and intraoperative nursing and postoperative compications nursing were observed. Resuts The successfu rate of paiative treatment was 93.1% in patients with maignant biiary obstruction by pacing pastic stent in fiberoptic duodenoscopic retrograde choangiopancreatography， and the postoperative re-bocking rate was 20.7%. The postoperative tota biirubin， direct biirubin， akaine phosphatase， aspartate transferase and aanine aminotransferase in patients was reduced significanty（P<0.05）. 45 cases were foowed up. The mean surviva time was（28.0±4.2） months（4-38 months）， the one-year surviva rate was 55.6%（25/45）， and the two-year surviva rate was 26.7%（12/45）. The postoperative compications rate was 8.6%. The compications were reieved or disappeared after active nursing. Concusion It is feasibe to pace pastic stent in fiberoptic duodenoscopic retrograde choangiopancreatography for paiative treatment of advanced maignant biiary obstruction， and the compication is ow. The compications can be aeviated or disappear through effective nursing treatment. 综上所述，通过纤维十二指肠镜逆行胆胰管造影放置胆道内塑料支架姑息治疗晚期恶性胆道梗阻是可行的，并发症较低；即使出现并发症，经有效护理治疗均可使并发症得到缓解或消失。
参考文献
[1]董广峰. ERCP与PTCD治疗恶性阻黄的对比分析[DD] . 济南.山东大学.2014.
[2]郭丽.蒋锦.朱婷婷.等. ERCP林后鼻胆管引流149例临床护理体会[J]. 中华全.
[3]黄纯秀.范金先.张艳. 综合护理对ERCP及EST患者的护理效果[J]. 实用临床医.
[4]吴瑜.秦鸣放.王庆.等. 内镜人金属支架姑息性治疗胆管远端恶性恒272例分析.
[5]张昊.经内镜逆行胆胰管造影胆道引流术解决肝外胆道恶性恒阻的临床疗效分.
[6]张?.黄平.张旺.经皮逆行胰胆管造影本或经皮经肝胆管引流本放置胆管支架.
[7]祝勇.朱卫.陈素明. PTCD及内支架置入森在治疗恶性梗阻性黄半应用价值.